2.3. Fundamentación teórica
2.3.8. Funcionamiento de un ciclón
The increasing media coverage given to the assisted suicides of Britons at Dignitas, and
of high-profile court cases like those involving Debbie Purdy331 and Tony Nicklinson,332
has not only fuelled the debate on assisted death in England and Wales, butevoked huge
public sympathy for those wanting assisted death to be legalised.333Some recent
documentaries are highlighted below.
In December 2008, the television programme Sky Real Lives aired the documentary
‘Right to Die’, about the assisted suicide of Craig Ewert at Dignitas in 2006.334 The
documentary covered the last four days of Ewert’s life, and showed him dying with his
wife at his side.335 In 2009, a film called ‘A Short Stay in Switzerland’, inspired by the
life and death of Dr Anne Turner was produced by the British Broadcasting Corporation
(‘BBC’).336Turner died at Dignitas in 2006, accompanied by her three children. In 2011,
the British author, Sir Terry Pratchett, took part in a BBC documentary which followed
the final days of a 71-year-old British man who travelled to Dignitas to die.337 The
documentary, called ‘Choosing to Die’, was centred on Pratchett’s belief in a right to
take his own life.338 There was also tremendous publicity surrounding Reginald Crews’
death in 2003.339 Crew was the first Briton to be publicly named as using the services of
Dignitas.340In the hope of promoting the legalisation of assisted suicide, Crew was
331
Purdy (HL)(ch1 n31). See also A Hirsh, ‘Debbie Purdy wins “significant legal victory” on assisted suicide’
The Guardian (London,31 July 2009).
332
S Boseley, ‘Tony Nicklinson: fight to die with dignity “will not be forgotten”’, The Guardian (London,23 August 2012).
333
P Saunders, ‘The Role of the Media in Shaping the UK Debate on “Assisted Dying”’ (2011)11(3) Med.Law.Int’l 239.
334 Ewert was a 59-year-old retired university professor who suffered from motor neurone disease. 335
T Moore, ‘Death was His Logical Choice’ (Sky News, 10 December 2008) <http://news.sky.com/story/ 655023/death-was-his-logical-choice> accessed 3 September 2013.
336
Turner had an incurable brain disease, progressive supranuclear palsy. She had seen her husband die from a closely related degenerative illness, and wanted to avoid the ‘long, slow demise’ that he had suffered. She believed it was ‘everybody’s right’ to be able to ‘die with dignity’. See R Savill, ‘By the time you read this, I will be dead’
The Telegraph (London,25 January 2006).
337
The documentary filmed 71-year-old British millionaire Peter Smedley ending his life at Dignitas, in the presence of his wife.
338
Pratchett, who was diagnosed with Alzheimer’s in 2008, is himself a supporter of assisted death.
339Crew was terminally ill with motor neurone disease. See‘No charges over assisted suicide’ (BBC News,9 April 2003) <http://news.bbc.co.uk/1/hi/england/merseyside/2933589.stm> accessed 19 June 2014. 340
accompanied to Switzerland by not only his wife, but by a television documentary crew
from ITV1.341
By giving the debate on the legalisation of assisted death in England and Wales such a high level of exposure, the media has not only helped shape the debate, but its coverage of suicide tourism cases has created a ‘vicious cycle’ in which greater public awareness of suicide tourism has encouraged greater numbers of people to pursue this option with news of this trend then receiving further media coverage.
3.5 Conclusion
The chapter examined the social, ethical and other influences affecting the development of the current law on assisted death in England and Wales. The influences examined were (i) religion, (ii) individualism, (ii) an aging population, (iv) sanctity of life,
(v) self-determination, (vi) professional ethics, (vii) the four principles of medical ethics (respect for autonomy, non-maleficence, beneficence, and justice in medical care), (viii) consequentialism and deontology, (ix) the doctrine of double effect, (x) quality of life, (xi) paternalism, (xii) scarcity of healthcare resources, (xiii) public trust in
physicians, (xiv) advances in medical technology, (xv) palliative care, (xvi) concerns over patient dignity, (xvii) concerns over a slippery slope, (xviii) protecting the vulnerable, (xix) the laws on assisted death in other jurisdictions, and (xx) media coverage. From an analysis of these influences, this chapter concludes that the current law is unsatisfactory, and that it fails to meet the needs of those seeking an assisted death. The reasons for this, are as follows.
Firstly, whilst the ethical influence of ‘sanctity of life’ may provide moral coherence to the current illegality of assisted death, this doctrine is upheld by neither the end-of-life medical decisions which are currently permitted, nor by the law which decriminalises suicide. The current level of public trust in the medical profession is one which exists despite physicians regularly making end-of-life medical decisions which hasten death. The chapter accordingly concludes that the legalisation of physician-assisted suicide would not undermine the integrity of the medical profession. Opposition by the GMC and BMA to the legalisation of physician-assisted suicide on these grounds is similarly unfounded, and is inconsistent with their own support for such end-of-life medical decisions which indirectly hasten death.
341
J Laurance, ‘Terminally ill man’s journey to Switzerland to find dignity - and death’ The Independent (London,21 January 2003).
Secondly, the chapter demonstrated that other ethical influences are growing in England and Wales, and are now challenging the moral coherence of the current prohibition on assisted death. These include self-determination, quality of life, patient dignity, and the medical ethical principle of autonomy. As these influences continue to make the withdrawal or withholding of life-sustaining treatment more morally acceptable, the current prohibition on assisted death for those who competently request it tends to become more questionable.
Thirdly, whilst seldom articulated in public debate, the chapter also found that the medical ethical principle of ‘justice in medical care’ (which provides that medical care is to be distributed fairly to all patients), combined with the increasing scarcity of healthcare resources (encouraging efforts to save limited healthcare resources for their most beneficial uses), tend to make end-of-life medical decisions such as the withdrawal or withholding of life-sustaining treatment from patients more morally acceptable. This, combined with advances in medical technology that merely prolong the dying process of a patient, further strengthens the moral argument in favour of allowing assisted death with appropriate safeguards.
This chapter considered the vulnerable groups within society, including those who are depressed, those who regard themselves to be a burden on others, and the elderly. In its analysis of the need to protect these vulnerable groups, the chapter concluded that this need has strongly influenced current laws, and is currently well satisfied. However, if physician-assisted suicide were to be legalised, the potential for alternative safeguards to protect such vulnerable groups was also noted. These include mental health
evaluations and adequate access to palliative care for those requesting an assisted death. The chapter found that social influences such as religion, where there is now a strong trend towards secularisation, should no longer be relied upon to justify the current prohibition on assisted death. Further, the trend towards individualism in England and Wales is a social influence which supports autonomy and self-determination.
Increased public awareness of the legality of assisted death in other jurisdictions, due to the media coverage of the ‘suicide tourists’ who travel abroad to end their life, has in turn raised interest in changing the current law on assisted death in England and Wales due to a perception that it does not meet the needs of either society, nor of those seeking an assisted death.
A key ethical influence considered by this chapter was ‘quality of life’. It is argued in this thesis that a competent terminally ill patient should be able to obtain an assisted death, based upon their own decision of the point at which their quality of life is so poor as to be unbearable and unacceptable. This issue will be examined fully in the following chapter.